Drones

 I am one of my own favorite comedians.  Perhaps you have seen me on the Johnny Carson show?  No, perhaps not then.  Sometimes I really crack myself up. I am easily entertained.  I don’t perform publicly, other than in small bit roles for my partner and patient while on the job.  My latest gag has to do with the power stretcher.  Once we get the patient on the stretcher and all wrapped up in blankets and strapped in, I stand at the head and dramatically levitate the patient by slowly raising my hands like a master prestidigitator, as my partner presses the up button, then just as we hit the top, I spread my hands out, like a conductor finishing a movement.  The dialysis nurses love it!  I take it that their days are generally lacking in comic diversion.

While taking a patient out to the ambulance, I realized for all the benefits of the power stretcher, we still have to load and unload it, so I wondered if perhaps the next generation power stretcher would be more robotic where we would not have to lay our hands on it to load and unload.  We can stand like foremen in a high tech warehouse and move the stretcher in and out simply by turning a knob on a remote control device,  It gets even better the more I think about it. 

 You know how soldiers living in the suburbs drive to work at their base in Las Vegas or Omaha or some Middle American city, take their desk in front of computer screens and go to war, launching missile strikes, flying predator drones, etc?  Picture EMS in a few years.  Instead of getting in our ambulances and going out on calls, risking life and limb while driving lights and sirens, and walking up three flights of wobbly stairs as cockroaches scatter at out feet, dealing with blood, vomit, decay, and unexpected violence, what if…?

 The paramedics of the future practice by remote control.  We use keyboards and joysticks.  A mechanical arm restrains the patient, while we identify the vein with a little red laser dot and fire the catheter in.  Using a stylus we tap the computer screen, checking a box for the drug we are going to give and the amount.  Zofran 4 mg SIVP over 2 minutes.  If the patient looks like they are about to vomit, no problem.  No need to quickly jump out of the way.  So they might splat on the camera, our camera will have automatic windshield wipers so our vision will only be briefly impaired.

 But I know this sounds too mechanical.  Where is the human touch, the caring?  Why we have paramedic drones.  Robots, and with time they will look less like department store mannequins and more like us.  Eventually, they will be so real people won’t even know they are not being treated by robots.  Their caregivers will look like us, complete with bad haircuts, sweating pores, occasional foul mouths, and sore backs.

And we may not be the only robots.  The nurses and doctors could be robots too.  And why not the patients?  I mean why be sick and in pain when your robot self could suffer for you.

Of course with the economy and the need to impose efficiencies, there will be mass mergers, and soon the EMS world will be all managed in one place by just a few super EMS -- let’s call them -- gamers.

And what fun they will have!  Since they control not only the EMTs, but the patients and the other medical staff, they can devise elaborate scenarios to mess with us.  “Hey,” one gamer says to the other.  “Let’s F--- with Medic G today. "  “Sounds like fun!”

 The ancient Greeks believed this was how their universe operated.  They were just pawns at the mercy of the gods who sat up on Mount Olympus and played with them while they drank wine and ate meat dripping with fat.  One could only hope to win favor with the gods and protection -- to be given gifts of strength and speed and not be sacrificed on a whim.  Maybe today, this is how it is for us too. 

 The gods that oversee us  start hitting all the buttons – fourth floor carry downs, frequent flier with same complaint, long triage lines,  incomprehensible dispatching, irritable nurses,  traffic, spitting patients, pagers going off, sirens, swearing, screaming, conflict, insanity.   All day long they ramp up the stress until at 4:58 the medic’s head starts spinning.  The gamers try to ease the tension back, but it has gone too far.  The head starts smoking, fire comes out of the nostrils and then the head completly blows off and fireworks shoot out of the medic’s open neck and then the screen goes blank.

Meanwhile the next day you come to work.  “Anyone see G?"   "No, he didn’t come in to work today."  And like so many others in the past, another one of us is gone with no trace, only rumor.  "Yeah, G.  I was at the Institute for the Insane yesterday and I swear I saw him walking the floor in just an untied Johnny, shuffling along with his bare butt hanging out the back of his gown and a vacant look in his eyes. "

 

 

 

 

Maps

 When I was a boy my father used to bring home maps for my sister and me. We would spread them out on the floor and he would pay us a nickel for every river we found or every mountain range or sea. As a result of this practice, I always did well in geography and on map reading tests.

Working on the ambulance I have always considered myself a good map man – at least until one time recently when I had to read one of our smaller print maps at night in an ambulance with poor front cab lights. Age.

Today, many of the newer employees have GPSs that they affix to the windshield at the start of the shift. I usually shake my head and say, I know the streets I’ll tell you how to go. One day while I worked on the patient in the back and my partner sat in the driver’s seat trying to program the GPS for an outer laying hospital, I just called out the directions. Get on 84…, etc. I looked up ten minutes later and saw my partner had indeed gotten on 84, but instead of going west, he had gone east. I screwed up. I thought he knew the town we were going to was west of the city, not east.

I just finished reading a book called Maphead, which was an interesting tour of maps and map lore, covering everything from the first antique maps to Goggle Earth.

The author lamented the inability of many people now days not just to read a map, but the ability to reckon, to use landmarks and the sun, and sense of direction to find their way.

Years ago I drove a cab in Alexandria, Virginia. To get my cab license, I had to take a test which included being able to write directions from one place to another without looking at a map. For a week before the test I poured over the city map till I had learned all the streets. I successfully passed my test and went on to really enjoy the job. I worked six days a week twelve hours a day. I knew how to get anywhere. I loved the varied passengers I carried and I loved the flow of the streets.

Driving a cab was a lot like being a paramedic. Everyday was different. You saw things you could never imagine, and you learned new skills. Finding your way was one of them. As much as I love patient care and medicine, I also love navigating the streets. I like knowing where the streets are and the best way to get to them. I navigate mainly from memory.

Working in a fly car in the city, I need to know where every street is. I don’t have a partner to read the map for me as I drive. Now I have been working in the city for nearing twenty years. Still sometimes there are streets I don’t know. Sometimes, I have to pull over and look at the map or else ask for a cross street on the radio.

Reading Maphead made me realize I had never really spent time pouring over a Hartford map like I used to pour over the Alexandria map. So I took it out and really started studying it. I saw street I had never heard of and locations of places I never knew existed. My goal is to memorize the map, to be able to on questioning give directions to any street or place in the city limits without consulting the map, to never have to pull over to check my way.

Unfortunately since writing this not a shift has gone by that I haven’t at least once had to stop and check a street location. I keep studying, but I think either my memory is frailer or I am more risk averse and would prefer to be sure than 97% sure.

The other interesting thing about the book was the description of old beautiful illustrated maps. I wish I had drawing ability. I would love to make my own beautiful map of Hartford, illustrated like those maps of the United States with Mount Rushmore in South Dakota, orange trees in Florida, and Kodiak bears in Alaska. I would put overturned cars off I-84, crazy PCPers shouting naked on Garden Street, do-ragged gunmen on Albany Avenue, snoring drunks at Park and Hungerford, chain-smoking paranoids on Farmington Avenue, heroin ODs apneic in the parking lot of the fast food restaurants on Weston Street, prisoners clutching their chest in the lockup on Lafayette Street, and old women with syncope at the churches on Blue Hills Avenue. Would it be a bestseller? Probably not, but I would get a kick out of it.

Jimmy Ryder

It has been almost a year since I was rotated out of my suburban post. I still occasionally do calls in that town, but I have largely lost touch with most of my regular patients of the last decade.  Last week, I was taking a patient from the hospital back to one of the local nursing homes in that town. I was driving and sitting up in the passenger seat with me was one of the nursing aides from the home.  I asked him how he liked working at the manor, and he said he did, and then I asked how my friend Jimmy Ryder was doing.   "Jimmy?" he said, "You mean the Viet Nam Vet, the little guy?  He's gone a couple a months now."

I asked for details, but he had little.  He didn't know if he died in the hospital or in his bed, or if the ambulance came or not.   He just came in one day and Jimmy's bed was stripped.

I wrote this about Jimmy Ryder five years ago.

***

It's Christmas eve. We get called to one of the local nursing homes for rib pain. The room number sounds familiar. As we wheel our stretcher through the lobby, "Good King Wenceslas" plays through the speakers.

Gently shone the moon that night, thou the frost was cruel.
When a poor man came in sight, gathering winter's fuel.

In the East Wing, the nurse hands me the paperwork. "Mr. Ryder says he needs more Percocets. He's requesting transport."

Mr. Ryder (Jimmy to me) is a tattooed biker, an emaciated COPDer with a long white beard. Almost sixty, he can't weigh more than a hundred pounds. He sits in his wheel chair, in his Rebels motorcycle jacket, wearing an oxygen cannula.

"I'm in real bad pain," he tells me in his whisper of a voice. "Fifteen on the scale." He nods as if to say it is the truth.

"Well, we'll check you out when we get you out in the ambulance," I say.

It seems he fell a couple weeks ago and cracked a rib.

I have taken him to the hospital at least ten times over the years. The night medics have taken him more. Nearly every time it is self-dispatched. He agitates the nurses until they call his doctor who after several calls relents and tells the nurses to go ahead and call an ambulance just to get him to stop pestering them. He gets pneumonia a lot and complains of the chest pain. It is always "real bad," he says. He goes to the hospital and gets sent back a couple hours later. He is rarely admitted, and in those cases it is usually for a COPD exacerbation.

While I don't like to categorize patients in this way, he does fall into the "pain in the ass" category. But a patient is a patient, and none of my paychecks has ever bounced, so I'm not really complaining. They'll be turkey with all its fixings on my feast table tomorrow. And besides, there is always something to be said for the familiar.

I see Jimmy nearly everytime we go into the nursing home. He is usually sitting out in his wheelchair in the main TV area. I say "Hey Jimmy! How'ya doing?" as I push the stretcher past going for someone else on the wing.

He lights up and says, "Not too bad, hanging in there."

That's the jist of our relationship.

Today in the ambulance, I have an EMT student do vitals as we start toward the hospital.

She chit chats with him.

"You've got all your Christmas shopping done?"

"Yeah, I just bought stuff for myself," he says. He tells her Dial-a-Ride took him to the Mall. His favorite store is Spensers where he gets a lot of novelty gag items.

"I buy presents for myself sometimes," she says. "How about you?" she asks me.

"I'm pretty much done."

"Well, unless you're going to the drug store when you get off, you're out of luck. Time's run out."

"I'm in good shape," I say. I think to myself if I get out in time, I'll probably make a quick stop at the liquor store where I'll buy myself some Christmas beer -- a case of Red Stripe. I always ask for a case of a specialty beer for Christmas. Last year it was Presidente from the Domminican. This year I want Red Stripe from Jamaica. My girlfriend was going to buy it for me, but she is still hung up at the hospital. I told her not to worry about it. I'd get it myself. There is a liquor store that doesn't close till eight on my way home. I'll drink the beer slowly over the course of the year, taking one out every now and then and drinking it slow. I'll buy other beer during the year, but this case -- my Christmas beer -- I'll stretch out.

Jimmy looks up at the EMT student and says, "This guy over here, me and him go back a long way."

"He's taken care of you before?" she says.

"Yeah." He nods at me and then says, "He's probably one of my best friends in the world."

I melt a little inside at his words. It also makes me terribly sad. I think of all his biker buddies -- Hoss and Snake and Big Steve -- and wonder if they are enjoying their winter's fuel at the Iron Hog without him tonight or if maybe they are all either in the cold ground or solitary in nursing homes themselves.

Jimmy looks up at me now, his eyes locking on mine. "I'm in real bad pain," he whispers urgently. "Fifteen on the scale."

-Christmas 2006